Should I plan for a natural vs. medicated birth?

Culturally so much of the information we receive about birth fixates on the intensity of labor and the fear of the unknown. Unsurprisingly there is an association between labor and pain in most people’s minds. Let’s be real – having a baby is no easy feat and this association makes sense! But before assuming you’ll need medical pain management, it may be helpful to explore some of the different techniques utilized in unmedicated vs. medicated labor.

A moment on language: Unmedicated labor is commonly referred to as a “natural birth.” We feel that this phrase is misleading; all birth is good and natural. We will be using the term unmedicated vs. medicated birth moving forward.

What is a medicated birth?

A medicated birth describes a labor in which a pregnant person elects to use medication-based pain relief interventions. At Mount Sinai West, Oula’s partner hospital in NYC, examples of these interventions for an intended vaginal birth can include epidural anesthesia, nitrous oxide (laughing gas), or IV medications (opioids). IV medications are often utilized in early labor, whereas an epidural or nitrous oxide are often utilized in the latter stages. Pain management can be a helpful tool, allowing the body to calm and ease itself toward dilating the cervix and relaxing the pelvis. We will be exploring what each of these medication-based pain relief options provides as well as common side effects associated with each.

IV opioids are commonly an option utilized in early labor. They can help the pregnant person get a few hours of rest as they prepare for the heightened, active stages of labor. This can be particularly beneficial for first-time pregnant people who may be caught in “prodromal labor,” which are contractions that have the intensity of labor but without the cervical progression of labor.

Mount Sinai West offers intravenous morphine or butorphanol (Stadol) but other maternity units may utilize fentanyl, meperidine (Demerol), or nalbuphine (Nubain). While opioids can be effective in diminishing early or prodromal labor pain, it is largely ineffective in providing relief during active labor and delivery.

While most pregnant people experience little to no side effects from these medications, some side effects include itching, nausea, vomiting, constipation, and drowsiness. Narcotics do cross the placenta and enter fetal circulation. Babies can metabolize narcotics but do so more slowly than an adult. It may cause possible changes in fetal heart rate while the baby is in utero or cause the baby to be drowsy after birth if utilized too closely to the time of delivery. The current consensus is that this small amount of narcotic use by the pregnant person likely has limited long-term adverse effects on the baby.

Epidurals are considered to be the most effective method of pain management in labor, used in three-quarters of births in the United States.

Epidurals are administered by an anesthesiologist in the labor room. The actual medication itself that goes into an epidural is a cocktail of anesthesia (such as bupivacaine, chloroprocaine, and lidocaine) and analgesia (typically a narcotic like fentanyl and sufentanil). In order to administer an epidural the pregnant person is asked to sit still on the edge of the bed with their back curved like the letter “C.” The skin is then cleaned and a local anesthetic (Lidocaine) is administered to numb an area of the lower back. A needle is then placed allowing a catheter to be introduced into the space in the spine. The needle is then withdrawn. An initial dose is administered by the anesthesiologist after which time the amount and frequency of dosing is directly controlled by the patient. After initial administration, pain relief begins within 10 to 20 minutes.

After an epidural is administered, most people lose sensation in their lower half making it so movement is difficult and walking is considered unsafe. A urinary catheter is often inserted until delivery or until the epidural is discontinued.

Common side effects of an epidural for the pregnant person include headache, lowered blood pressure, itchy skin, and prolonged first stage of labor/difficulty feeling the urge to push. This drop in blood pressure in the pregnant person can cause a change in fetal heart rate, necessitating medication to be administered to improve blood pressure. The medications administered in an epidural do cross the placenta and enter fetal circulation but often do so in minimal amounts and have no documented long-term adverse effects on the baby.

Nitrous oxide (laughing gas) is a fast-acting tasteless, odorless gas offered as a method of pain management in labor. It is administered via inhalation through a hand-held face mask. Nitrous oxide usually takes effect within one minute of inhalation with the effects lasting about 3-5 minutes. It is recommended to start inhaling 30 seconds prior to the start of a contraction for maximum efficacy. While nitrous oxide does not have the same numbing effect as IV medications or epidurals do, it does induce a general sense of calmness that makes contractions more tolerable.

Autonomy is a benefit to nitrous oxide use. It can be utilized as needed in labor and the amount utilized is entirely controlled by the pregnant person. The effects are short-lived and while it can cross the placenta, it has limited to no impact on the baby and it does not limit the person’s ability to move. Common side effects of nitrous oxide include nausea, vomiting, dizziness, drowsiness, or a reduced sense of awareness (feeling “high”).

What is an unmedicated birth?

An unmedicated birth is when the pregnant person elects not to use medication-based pain management tools in their labor. But this does not mean they go into labor unprepared or unarmed. Non-medicine-based pain management options include hydrotherapy, aromatherapy, use of a TENS machine, and massage. Read more about Creating comfort at the hospital. There are also laboring techniques that center on breath work and mind/body connection such as hypnobirthing and the Bradley method. Having a doula to support you throughout your labor is another evidence-based tool. Evidence Based Birth’s research on working with a doula has found a 39% decrease in the risk of a C-birth, 15% increase in the likelihood of a spontaneous vaginal delivery, and 10% decrease in the use of any medications for pain relief. Read more about Top 9 Reasons to Hire a Doula.

Can I change my mind?

People sometimes ask if there is ever a stage where it’s “too late” to get an epidural. Short of the baby imminently crowning there is no last call for pain management. We are judgment-free about whether you would prefer to be medicated or unmedicated, and you are welcome to change your mind at any time in your labor!

Some individuals in labor find it very distracting or even demoralizing to be asked more than once if they wish to utilize a medication-based pain relief tool. If you think you might feel this way, let us know during your prenatal care. We can ensure your labor team is well aware of this by writing it into your birth plan. Your labor team will know that you are aware of the option of pain management but that they should not ask you if you are interested in it unless you prompt it.

Conclusion

Preparing for birth is a lot like preparing for a marathon; you will do months of reading and researching, weeks of labor stimulation and stretching, and hours of laboring! And while labor and birth can be navigated by the pregnant person’s intuition, knowing techniques and tools to guide you through this intense process is a smart approach. We say it often at Oula – there is no “right way” to give birth! Knowing all of the options available to you and exploring which ones align best with you and your birth goals will allow you to approach your due date and labor with confidence.